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What do villages in the Amazon jungles, the peaks of Mount Everest and Mars have in common? All are remote places where doctors may not be available to provide medical care for patients. Now, doctors can reach patients via television and computers — a concept called telemedicine. One day, space explorers may use telemedicine to consult with doctors on Earth. Telemedicine research is being conducted by Dr. Ronald Merrell, director of the Medical Informatics Technology Applications Consortium — a NASA Research Partnership Center managed by the Space Partnership Development program at the Marshall Center.

Photo: Merrell (Virginia Commonwealth University)

What do villages in the Amazon jungles, the peaks of Mount Everest and Mars have in common? All are remote places where doctors may not be available to provide medical care for patients.

But now, thanks to high-tech electronics, doctors do not always have to be with the patient to assist with medical care. Instead, doctors can literally visit patients or consult with other doctors via television and/or computers — a concept called "telemedicine." One day, these "television calls" may become routine for the first humans living on lunar and Martian outposts.

"Telemedicine changes the way we approach medical care, both intellectually and logistically," explains Dr. Ronald C. Merrell, director of the Medical Informatics Technology Applications Consortium, a NASA Research Partnership Center at Virginia Commonwealth University in Richmond, Va.

"And with the nation embarking on a new space exploration voyage, back to the Moon and onto Mars, long-term medical care becomes even more important for space travelers," adds Merrell. "The constraints of providing medical treatment using telemedicine to patients at remote places on Earth and to people in space are similar, so what we learn on Earth can be applied to using telemedicine for human space exploration."

Merrell, a professor of surgery, recently returned from Sucua, Ecuador, where his medical team and local physicians set up a mobile unit for diagnosing and treating tropical diseases in Amazon villages that are only reachable by small planes or canoes. They installed computers, cameras and other equipment, along with medical and surgical tools. Through this technology, Merrell and his team can consult with their colleagues in South America.

The Medical Informatics and Technology Applications Consortium has been a partner with Cinterandes Foundation in Cuenca, Ecuador, for several years. The foundation has provided a mobile surgical facility that transmits the vital signs of patients in Ecuador to doctors 3,000 miles away at Virginia Commonwealth University. In one case, an anesthesiologist at the university, monitoring a surgery in Ecuador, noticed a life-threatening irregularity in the patient's heart rhythm. He warned the surgeons, who responded in time to prevent harm to the patient.

"Testing technologies that provide medical care to space crews not only benefits individuals who need medical care, but entire countries," says Merrell. "Medical students and physicians from across the globe have visited Virginia Commonwealth University, learned about telemedicine and gone back to their countries to start telemedicine programs."

For the past several years, the Medical Informatics and Technology Applications Consortium has tested different telemedicine units operating under a variety of conditions in many locations — including Mount Everest, the Artic Circle, Russia, Brazil, Mongolia and Kenya. Telemedicine is used not only to consult with colleagues, but also to train medical students — requiring them to watch experts perform surgeries and other procedures.

"Providing the best medical training to students and practicing physicians is one of the most rewarding aspects of this research," Merrell says. "One of my teachers at Ensley High School in Birmingham, Ala., was the first person who got me interested in science, so I believe it is important to inspire the next generation. What could be better than making it possible for students and doctors — no matter where they are studying or practicing medicine — to learn from the world's leading medical experts?"

Merrell, an Alabama native, obtained a bachelor's degree in chemistry from the University of Alabama in Tuscaloosa and doctorate of medicine from the University of Alabama in Birmingham. He completed his residency and fellowship training at the Barnes Hospital at Washington University in St. Louis. He has held prestigious positions at Stanford University in Palo Alto, Calif., and Yale University School of Medicine in New Haven, Conn. He began his relationship with NASA in 1984 when he was a professor of surgery at the Texas Medical Center in Houston near NASA's Johnson Space Center. He led programs in clinical medicine, education and research, and his first telemedicine project funded by NASA provided care as part of a relief effort in Armenia.

Now, Merrell's team is testing how doctors might use telemedicine to train space crews to perform surgery. This summer, doctors from Virginia Commonwealth University will fly aboard NASA's KC-135 aircraft — a plane that flies roller coaster patterns and exposes researchers to a few minutes of low-gravity in which they float about like space crews. Merrell and his fellow researchers will practice surgery techniques, so they can experience how space conditions affect the way surgery is conducted.

"We know that performing surgery and other medical procedures in space will be different from working on Earth," Merrell says. "The more we can learn, the better we can help space crews complete long, productive exploration missions to the Moon, to Mars and beyond."